October 7, 2013 | 4:03 PM | Dr. Steve Schlozman and Dr. Gene Beresin

Sadness And Beyond: Psychiatrists Respond To Death Of Newton Teen

More than 1,000 origami cranes at a 2012 suicide prevention event titled ‘Walk Out of Darkness.” (US Navy on Wikimedia Commons)

The news darkened Sunday for everyone it reached. Karen Douglas, the 18-year-old Newton North High School student who’d been reported missing on Thursday, had been found dead Saturday night in Natick. Official sources said only that the death was not “suspicious,” and did not appear to have been caused by foul play. But a heartbroken post on Reddit by Sonya Maria Douglas, who identified herself as Karen’s sister, was headlined without euphemism: “Karen Douglas found in suicide. Thank you Reddit for your prayers and actions.”

We asked Dr. Steve Schlozman and Dr. Gene Beresin to respond, and in particular, to offer guidance on how best to discuss and absorb such painful news. They are child and adolescent psychiatrists at Massachusetts General Hospital and are directors of the Clay Center for Young Healthy Minds.

By Dr. Steve Schlozman and Dr. Gene Beresin
Guest contributors

We’ve tried over and over to begin this post. We want to, need to and indeed feel we have an obligation to write about adolescent suicide following the possible suicide of a teen in Newton last week. Gene and I have read over and over the well-publicized, incredibly moving, and palpably sad Reddit post that the girl’s sister penned.

We’re just so very sad.

And that’s an okay place to start…really the only place to start. We could discuss the statistics, the risk factors, the phenomenon of copycat suicides. We could talk about early detection and prevention, and we could talk about community support.

Still, we too often leap to these numbers – solid things, measurable things – because we can’t imagine falling into the abyss of pain that these stories create. People suffer with illnesses; that’s the definition of illness. But a young life ending is heartwrenching, whether by suicide or any other means.

And suicide just feels different. We know that people who take their own lives are in immense pain. We know that the dark cloud of stigma hovers over those who suffer mental illness. We know that feeling suicidal can be intensely private. Those who take their own lives feel profoundly alone. We know as well that we are, paradoxically, herd animals…that we don’t do well when we’re alone. A condition that makes us feel as if we deserve to be lonely makes us suffer all the more. We are least compelled to reach out exactly at the time when we can be most powerfully helped by each other. And the suffering is often greater when we realize the pain it may deliver to those who love us. Even then, we can’t reach out.

Combine all that – the stigma, the pain, the swirling desperation and the sense of utter and desolate loneliness – and we retreat instead to our statistics and our epidemiology.

There will be time for those facts in just a few lines. But for now, let’s note, together, that we are sad and that we are saddened. It is impossible to move forward in the absence of that acknowledgement.

Remember that suicide is a symptom. It is not terribly common, thank God, but neither is it rare. Young people do not die often, so when we say that suicide is the third leading cause of death in teens and young adults (automobile accidents and homicide are the first two) we need to remember that this doesn’t mean that suicides happen with great frequency. According to the Centers for Disease Control and Prevention, youth suicide accounts for about 4600 deaths per year. It ought to be obvious that this is an intolerable number.

Ask around. Scarcely anyone makes it through middle or upper school without another student attempting serious self-harm. In fact, the CDC estimates that about 16% of kids contemplate suicide yearly and almost 8% make an attempt. In high-pressure environments, these numbers increase dramatically. Remember that “high-pressure” can mean poverty and deprivation as well as intense academic stress. Kids of all ilks are vulnerable.

And yet we don’t talk about suicide, and in many ways this makes serious self-harm quite similar to other forms of psychiatric suffering. One in five kids will suffer a psychiatric illness in their childhood or adolescence, and yet we almost never discuss this with them or each other. We can’t seem to acknowledge when the self, itself, suffers.

Does this mean that the presumed suicide in today’s papers could have been prevented? Could better education and greater tolerance have made a difference?

We can’t possibly know the answer to that query.

But we can say with certainty that by better educating the public about these issues, we stand a better chance of preventing further harm to more kids. Early detection and prevention studies have proven this multiple times over.

Suicidal thoughts and behavior are most commonly a symptom of a mood disorder. In fact, the three most common risk factors for suicide among kids are 1) a mood disorder, 2) substance abuse, and 3) a previous attempt. About 90% of kids who take their own lives meet criteria for a serious psychiatric illness. The most common illness that leads to suicide is Depression. Bipolar Disorder, early psychosis and substance abuse also increase risks.

Kids, though, are different from adults. They can be more impulsive. They can be rash. Breaking up with a girlfriend or boyfriend, not making the school play, a fight with parents or friends – all of these can, rarely, be enough to provoke self harm. That’s why substance abuse is especially dangerous. The disinhibition that substances afford make impulsivity that much more likely.

So we remain vigilant. We look for signs of depression or mania. We watch for substance abuse. We stand guard for kids who isolate, we worry for the kids who withdraw, who show academic decline or uncharacteristic lack of interest in typical activities, and we check on kids who post provocatively about suicide on the Internet. In fact, many potential acts of self-harm are averted today precisely because friends alert families when their buddy’s social media becomes frightening.

We also know that among teens there is a tendency to romanticize suicide. This is understandable; a desperate act with great potential publicity can be appealing to an adolescent brain. This is of course a general statement, and each episode of suicide is different. But never forget the tendency for kids to emulate that which they romanticize.

“Copycat suicide” is one of the most carefully researched, documented and proven facts about teenagers. It typically happens within two weeks after a well publicized suicide – often a celebrity, but also the suicide of a character on TV, in the movies, or someone written about online, in newspapers or magazines. These observations have led to specific guidelines about how best to report on suicide in the community. They draw from the fact that suicides are often copied by kids if the individual is idealized, if there is extensive coverage, a detailed description of the death, or if it is glamorized. These proscriptions are recommended by both the CDC and the American Foundation for Suicide Prevention (AFSP), and they include:

•Inform the public without sensationalizing
•Avoid providing excessive detail on the method
•Show the consequences for the survivors
•Don’t overestimate the frequency of suicide.
•Report on suicide as a public health issue
•Don’t give simple explanations of cause (“He was dumped by his girlfriend and killed himself; or he was fired from his job and shot himself.”)
•Give information on sources for help
•Don’t refer to suicide as “successful” or a “failed attempt,” rather “she died by suicide” or “killed herself,”

Finally, and when tolerated and tolerable, we support one another. Coming together as a community is a long-established cultural tradition. That’s why we sit shiva; that’s why we have wakes. But just because we desperately want to help, it doesn’t mean a family wants or needs it at the moment. Some do, but others need private space and time. If a family requests to mourn in peace, let them do so. If a family feels they need help, let us help them. There is nothing more comforting to humans than other humans. We have hundreds of thousands of years of evolution promoting this behavior. Trust in your desire to reach out. You and those you are helping will feel better.

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Massachusetts is the leading laboratory for health care reform in the nation, and a hub of medical innovation. From the lab to your doctor’s office, from the broad political stage to the numbers on your scale, we’d like CommonHealth to be your go-to source for news, conversation and smart analysis. Your hosts are Carey Goldberg, former Boston bureau chief of The New York Times, and Rachel Zimmerman, former health and medicine reporter for The Wall Street Journal.

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